CIDNY FACT SHEET Preventative Services Under the Affordable Care Act

The information below is from Healthcare.gov. Some of the material in this fact sheet was edited for readability. If you have any questions about this material, please refer to the original website or contact CIDNY and ask to speak to a benefits counselor.

Preventive health services for adults

Most health plans must cover a set of preventive services like shots and screening tests at no cost to you. This includes Marketplace private insurance plans.

Free preventive services

When services are delivered by a network provider, all Marketplace plans and many other plans must cover the following list of preventive services without charging you acopaymentorcoinsurance. This is true even if you haven’t met your yearlydeductible.

  1. Abdominal aortic aneurysm one-time screeningfor men of specified ages who have ever smoked
  2. Alcohol misuse screening and counseling
  3. Aspirin useto prevent cardiovascular disease for men and women of certain ages
  4. Blood pressure screening
  5. Cholesterol screeningfor adults of certain ages or at higher risk
  6. Colorectal cancer screeningfor adults over 50
  7. Depression screening
  8. Diabetes (Type 2) screeningfor adults with high blood pressure
  9. Diet counselingfor adults at higher risk for chronic disease
  10. Hepatitis B screeningfor people at high risk, including people from countries with 2% or more Hepatitis B prevalence, and U.S.-born people not vaccinated as infants and with at least one parent born in a region with 8% or more Hepatitis B prevalence.
  11. Hepatitis C screeningfor adults at increased risk, and one time for everyone born 1945 – 1965
  12. HIV screeningfor everyone ages 15 to 65, and other ages at increased risk
  13. Immunization vaccinesfor adults — doses, recommended ages, and recommended populations vary:
  14. Diphtheria
  15. Hepatitis A
  16. Hepatitis B
  17. Herpes Zoster
  18. Human Papillomavirus (HPV)
  19. Influenza (flu shot)
  20. Measles
  21. Meningococcal
  22. Mumps
  23. Pertussis
  24. Pneumococcal
  25. Rubella
  26. Tetanus
  27. Varicella (Chickenpox)
  28. Lung cancer screeningfor adults 55 - 80 at high risk for lung cancer because they’re heavy smokers or have quit in the past 15 years
  29. Obesity screening and counseling
  30. Sexually transmitted infection (STI) prevention counselingfor adults at higher risk
  31. Syphilis screeningfor adults at higher risk
  32. Tobacco Use screeningfor all adults and cessation interventions for tobacco users

Preventive health services for children

Most health plans must cover a set of preventive health services for children at no cost when delivered by a provider in your network. This includes Marketplace and Medicaid coverage.

Coverage for children’s preventive health services

All Marketplace health plans and many other plans must cover the following list of preventive services for children without charging you a copayment or coinsurance. This is true even if you haven’t met your yearly deductible.

  1. Alcohol and drug use assessmentsfor adolescents
  2. Autism screeningfor children at 18 and 24 months
  3. Behavioral assessments for children ages:0 to 11 months,1 to 4 years,5 to 10 years,11 to 14 years,15 to 17 years
  4. Blood pressure screening for children ages:0 to 11 months,1 to 4 years,5 to 10 years,11 to 14 years,15 to 17 years
  5. Cervical dysplasia screeningfor sexually active females
  6. Depression screeningfor adolescents
  7. Developmental screeningfor children under age 3
  8. Dyslipidemia screening for children at higher risk of lipid disorders ages:1 to 4 years,5 to 10 years,11 to 14 years,15 to 17 years
  9. Fluoride chemoprevention supplementsfor children without fluoride in their water source
  10. Gonorrhea preventive medicationfor the eyes of all newborns
  11. Hearing screeningfor all newborns
  12. Height, weight and body mass index (BMI) measurements for children ages:0 to 11 months,1 to 4 years,5 to 10 years,11 to 14 years,15 to 17 years
  13. Hematocrit or hemoglobin screeningfor all children
  14. Hemoglobinopathies or sickle cell screeningfor newborns
  15. Hepatitis B screeningfor adolescents at high risk, including adolescents from countries with 2% or more Hepatitis B prevalence, and U.S.-born adolescents not vaccinated as infants and with at least one parent born in a region with 8% or more Hepatitis B prevalence: 11 – 17 years.
  16. HIV screeningfor adolescents at higher risk
  17. Hypothyroidism screeningfor newborns
  18. Immunization vaccinesfor children from birth to age 18 — doses, recommended ages, and recommended populations vary:
  19. Diphtheria,Tetanus,Pertussis (Whooping Cough)
  20. Haemophilus influenzae type b
  21. Hepatitis A
  22. Hepatitis B
  23. Human Papillomavirus (PVU)
  24. Inactivated Poliovirus
  25. Influenza (flu shot)
  26. Measles
  27. Meningococcal
  28. Pneumococcal
  29. Rotavirus
  30. Varicella (Chickenpox)
  31. Iron supplementsfor children ages 6 to 12 months at risk for anemia
  32. Lead screeningfor children at risk of exposure
  33. Medical history for all children throughout development ages:0 to 11 months,1 to 4 years,5 to 10 years,11 to 14 years,15 to 17 years
  34. Obesity screening and counseling
  35. Oral health risk assessment for young children ages:0 to 11 months,1 to 4 years,5 to 10 years
  36. Phenylketonuria (PKU) screeningfor newborns
  37. Sexually transmitted infection (STI) prevention counseling and screeningfor adolescents at higher risk
  38. Tuberculin testing for children at higher risk of tuberculosis ages:0 to 11 months,1 to 4 years,5 to 10 years,11 to 14 years,15 to 17 years
  39. Vision screeningfor all children

Preventive health services for women

Most health plans must cover additional preventive health services for women, ensuring a comprehensive set of preventive services like breast cancer screenings to meet women’s unique health care needs.

Comprehensive coverage for women’s preventive care

When services are delivered by an in-network provider, all Marketplace health plans and many other plans must cover the following list of preventive services for women without charging you a copayment or coinsurance. This is true even if you haven’t met your yearly deductible.

  1. Anemia screeningon a routine basis
  2. Breastfeeding comprehensive support and counselingfrom trained providers, and access to breastfeeding supplies, for pregnant and nursing women
  3. Contraception: Food and Drug Administration-approved contraceptive methods, sterilization procedures, and patient education and counseling, as prescribed by a health care provider for women with reproductive capacity (not including abortifacient drugs). This does not apply to health plans sponsored by certain exempt “religious employers.”Learn more about contraceptive coverage.
  4. Folic acidsupplements for women who may become pregnant
  5. Gestational diabetes screeningfor women 24 to 28 weeks pregnant and those at high risk of developing gestational diabetes
  6. Gonorrhea screeningfor all women at higher risk
  7. Hepatitis B screeningfor pregnant women at their first prenatal visit
  8. Rh Incompatibility screeningfor all pregnant women and follow-up testing for women at higher risk
  9. Syphilis screening
  10. Expanded tobacco intervention and counselingfor pregnant tobacco users
  11. Urinary tract or other infection screening

Get more information about services for pregnant women from HealthFinder.gov

Other covered preventive services for women

  1. Breast cancer genetic test counseling (BRCA)for women at higher risk
  2. Breast cancer mammography screeningsevery 1 to 2 years for women over 40
  3. Breast cancer chemoprevention counselingfor women at higher risk
  4. Cervical cancer screeningfor sexually active women
  5. Chlamydia infection screeningfor younger women and other women at higher risk
  6. Domestic and interpersonal violence screening and counselingfor all women
  7. Gonorrhea screeningfor all women at higher risk
  8. HIV screening and counselingfor sexually active women
  9. Human Papillomavirus (HPV) DNA testevery 3 years for women with normal cytology results who are 30 or older
  10. Osteoporosis screeningfor women over age 60 depending on risk factors
  11. Rh incompatibility screeningfollow-up testing for women at higher risk
  12. Sexually transmitted infections counselingfor sexually active women
  13. Syphilis screeningfor women at increased risk
  14. Tobacco use screening and interventions
  15. Well-woman visitsto get recommended services for women under 65

September 2017Page 1 of 4